Discovery Language Academy

Discovery Language Academy
Portuguese United for Education
128 Union Street
New Bedford, MA.02740
Tel: 508-997-8295
Email: [email protected]
Web: discoverylanguageacademy.org
____________________________________________________________________________________________
StudentApplication/FichaIndividualdoAluno Adultstudents-FillOutParts1,3,and4
TobefilledoutbytheSchool/ApreencherpelaEscola
RegistrationNumber/NúmerodeMatrícula:________________________________________
DayofRegistration/DataemquefoiMatrículado:____________________________________
Part1-InformationabouttheStudent/InformaçãosobreoAluno
Student’sFullName/NomeCompletodo(a)Aluno(a):
____________________________________________________________________________
DateofBirth(Day/Month/Year)/DatadeNascimento(Dia/Mês/Ano)____________________
CompleteAddress/EndereçoCompleto:____________________________________________
BirthPlace/LugarondeNasceu:___________________________________________________
Nationality/Nacionalidade:_______________________________________________________
HousePhoneNumber/TelefonedeCasa:___________________________________________
CellNumber/Telemóvel:_________________________________________________________
Email:________________________________________________________________________
SchoolStudentattends/EscolaqueFrequenta:________________________________________
Address/Direção:_______________________________________________________________
Grade/Grau:___________________________________________________________________
Part2-InformationabouttheParents/InformaçãoacercadosPais
Father’sName/NomedoPai:_____________________________________________________
Nationality/Nacionalidade:_______________________________________________________
HomePhoneNumber/TelefonedeCasa:____________________________________________
CellNumber/Telemóvel:_________________________________________________________
Email:________________________________________________________________________
Occupation/Profissão:___________________________________________________________
WorkPlace/LocaldeTrabalho:_____________________________________________________
WereyouastudentatPUE?FrequentouaEscolaPUE?_________________________________
Whatyeardidyougraduate?/EmqueanoGraduou?__________________________________
Mother’sName/NomedaMãe:___________________________________________________
Nationality/Nacionalidade:_______________________________________________________
CellNumber/Telemóvel:_________________________________________________________
Email:________________________________________________________________________
Occupation/Profissão:___________________________________________________________
WorkPlace/LocaldeTrabalho:____________________________________________________
WereyouastudentatPUE/FrequentouaEscolaPUE?_________________________________
Whatyeardidyougraduate/EmqueanoGraduou?___________________________________
Part3-IsthereanyoneinyourFamilywhoisinthePortugueseSchool/Temalgummembrode
famíliaafrequentarestaescola?
Name(s)/Nome(s):_____________________________________________________________
Relationship/Relaçãocomoaluno(a):___________________________________
Part4-EmergencyContacts/ContactoemCasodeEmergência:
1-Name/Nome:________________________________________________________________
Relationship/Relaçãocomo(a)aluno(a):____________________________________________
Address/EndereçoCompleto:_____________________________________________________
HomePhoneNumber/TelefonedeCasa:____________________________________________
Cell/Telemóvel:________________________________________________________________
Email:________________________________________________________________________
2-Name/Nome:_________________________________________________________________
Relationship/Relaçãocomo(a)aluno(a):____________________________________________
Address/EndereçoCompleto:_____________________________________________________
HomePhoneNumber/TelefonedeCasa:____________________________________________
Cell/Telemóvel:____________________________________________________________
Email:________________________________________________________________________
Otherinformation,suchasallergiesormedications/Outrainformaçãoquejulguedeutilidade:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________